Is your auto accident covered by PIP Insurance?

Do you know whether your claims is covered by PIP or not? Have you been injured in a motor vehicle accident? Is your claim covered? There are numerous court factors considered in making the determination. Here is some of the research on that topic.

The statute's definition of "personal injury protection" is detailed, but it does not specify whether merely "an accident" will trigger coverage or whether a "motor vehicle accident" is required. The statute uses the term "the accident" six times, and the phrase "the date of accident" once, without expressing whether "the accident" contemplates, or does not contemplate, an automobile or motor vehicle accident.

Personal injury protection consists of provisions of a motor vehicle liability policy which provide for payment to the named insured in the motor vehicle liability policy and members of the insured's household, any authorized operator or passenger of the named insured's motor vehicle including a guest occupant, up to an amount of $2,500 for each such person for payment of all reasonable expenses arising from the accident and incurred within three years from the date thereof for necessary medical, surgical, Xray and dental services, including prosthetic devices, and necessary ambulance, hospital, professional nursing and funeral services, and in the case of an income producer, payment of benefits for loss of income as the result of the accident; and where the person injured in the accident was not an income or wage producer at the time of the accident, payments of benefits must be made in reimbursement of necessary and reasonable expenses incurred for essential services ordinarily performed by the injured person for care and maintenance of the family or family household.

The insurer providing loss of income benefits may require, as a condition of receiving such benefits, that the insured person furnish the insurer reasonable medical proof of his injury causing loss of income. The personal injury protection in this paragraph specified shall not exceed $2,500 for all benefits, in the aggregate, for each person.

The benefits required by this Act shall be payable without regard to the fault or nonfault of the named insured or the recipient in causing or contributing to the accident, and without regard to any collateral source of medical, hospital, or wage continuation benefits. An insurer paying benefits pursuant to this Act shall have no right of subrogation and no claim against any other person or insurer to recover any such benefits by reason of the alleged fault of such other person in causing or contributing to the accident.

All payments of benefits prescribed under this Act shall be made periodically as the claims therefor arise and within thirty (30) days after satisfactory proof thereof is received by the insurer subject to the following limitations:

The coverage described in this Act may prescribe a period of not less than six months after the date of accident within which the original proof of loss with respect to a claim for benefits must be presented to the insurer.

The decision in Le v. Farmers Texas County Mutual Insurance Co. considered whether this statute permitted the State Board of Insurance to promulgate a policy that required a "motor vehicle accident" and concluded that it did. That court reasoned that "[i]t is likely that the statewide cost for injuries which happen to occur in a car is higher than the cost of paying for injuries which result from a motor vehicle accident." It gave deference to the Board, concluding, "[w]e do not find the Board's construction repugnant to the statute."

The reasoning in Le v. Farmers Texas County Mutual Insurance Co. is sound. It is certainly reasonable and permissible for a policy providing personal injury protection to require the occurrence of a "motor vehicle accident" before coverage is applicable. An insurer paying personal injury protection coverage has no right of subrogation for the fault of another person in causing or contributing to "the accident." does not prohibit automobile policies issued in this state from requiring that the injuries be sustained as a result of a "motor vehicle accident."

However, the court found that a motor vehicle accident occurs when one or more vehicles are involved with another vehicle, an object, or a person, the vehicle is being used as a motor vehicle, and a causal connection exists between the vehicle's use and the injury-producing event, and
driver's injury resulted from a "motor vehicle accident" and entitled him to PIP benefits. Texas Farm Bureau Mut. Ins. Co. v. Sturrock, 146 S.W.3d 123 (Tex. 2004).

There is hope out there that your PIP may cover your claim. Give us a call if you have any questions. We are San Antonio Personal Injury Lawyers here to help you! We care about your legal needs.

Had an auto accident, come see us

Many people believe that handling their own personal injury case is simple. The problem stands from the fact that, insurance companies have their legal team ready for battle. That means that you, without your own team, have no chance of beating them.

Insurance companies have been dealing with personal injury cases longer than most of us been alive. From the adjusters, their whole world revolves around giving you, the injured person, the minimal amount for your injuries. If need be, insurance companies have a group of experts that will testify against your case in Court.

Because of these facts, you need to be ready to have a legal team of your own. Since personal injury cases are "contingency" cases, you should not hesitate to have a legal team when you have been injured by another driver.

If you have suffered injuries as a result of an accident, give us a call. We helped numerous people in Texas get the settlement that they deserve. We handle broken bones, brain injuries, multiple injuries, lacerations, scars, puncture wounds, amputations, death, and many more.

Do not attempt to get the results that you deserve by yourself. Let us help you win your fight for you. This is why we tell you, we care about your legal needs!

Settlement on personal injury cases

Many people attempt to settle their own personal injury claim with the insurance adjusters. Although we believe this to be a mistake, enclosed we will provide you, the consumer, with points to remember if you decide to settle without an attorney.

Insurance companies are not your friends. The adjuster will talk to you in a friendly manner, until is time to pay. Remember that their bottom line, not yours its important to them. The adjuster will employ delay tactics to make you want to settle for less. DON'T FALL FOR IT.

The key to a successful personal injury claim is your injuries. The more severe the injuries, the better the settlement that you can expect. A very simple general rule is to ask for twice the medicals for a soft tissue injury and three times the medicals for fractures, lacerations or more severe injuries.

The insurance company has a duty to "in good faith" attempt to settle the case promptly with the other side, in this case you. However, they can and often do, breach that duty by their delays. In many cases you can used this to your advantage.

Remember that your property damage and personal injury are two separate and distinct claims, even though the insurance will treat them as one. Do not compromise one with the other one.

Once the injury happens, do not take long to obtain treatment. Insurance companies will not pay you if you have delays in treatment. The general rule is no more than two weeks.

Your medicals should be directly proportionate to your injury. In other words, do not have thousands of dollars in medicals if your property damage was less than one thousand dollars. This could get you in the adjuster not wanting to pay for all the medicals.

Always remember to ask for reductions from your medical providers. The more that you can reduce, them more that you can keep.

These general rules are only to be used as a guide. We always recommend that you consult with a personal injury lawyer in your area. Since insurance company adjusters have many tools to their disposal, you should have your own, one of them been your attorney.

The President wants to regulate the insurance industry

As our President talks to the nation on his Presidential News Conference, he mentioned that one of his pillars has to do with health care reform. One of his ideas is to regulate the insurance industry, based on the AIG scandal.

The only problem with that, as we see it, this could be potentially dangerous when it comes to settling case for personal injury claims. Although we would not speculate, we could see that if the government steps in, and regulates the industry, they would also dictate how much to pay for claims.

On the other hand, if the insurance companies are regulated, then we would not have the need to cap non-economical damages for claims, which has minimized the results obtain for those who need it the most. Since Texas has a cap, we have seen a raise in negligence by doctors, without having the doctors concern about loosing anything or even feeling sorry for their negligence, since they cannot be touched.

We can only wait to see how our economy is going to affect the way that personal injury attorneys are capable of helping those who have been affected by the negligence of others.

The Baez Law Firm, P.C. is a general practice law firm that is ready to help you during difficult times. We handle bankruptcy, criminal law, personal injury, family law, business law, consumer law, litigation, and appeals.